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Charlie Melancon (left) issued a statement shortly after he left a two-hour sit-down with party leaders last week to say the group would work with 'members in both chambers and on both sides of the aisle.'
AP Photo

Digg/Buzz It Up

POLITICO 44

Moderate Democrats last week told their leaders all the things they don’t want them to do with health care reform.

Don’t model public coverage on Medicare. Don’t force doctors or small businesses to participate. And don’t shut out Republicans.

But each concern speaks to a single, overarching plea: Please don’t go too far left of the Senate.

Health care was never going to be easy, not even in the House, where Democrats have a sizable margin. But despite a lukewarm response from both the White House and the Senate, House Democratic leaders still hope to approve a robust new network of government-sponsored health care this year.

That plan hit a roadblock last week when moderate Democrats sought and got time with their leaders to protest “the process and direction” in which the authors were headed. Some moderate Democrats even threatened to reach across the aisle to Republicans if that’s what it takes to change the legislation.

Louisiana Rep. Charlie Melancon, chief spokesman for the 52-member Blue Dog Coalition, issued a statement shortly after he left a two-hour sit-down with party leaders to say the group would work with “members in both chambers and on both sides of the aisle.”

The session included leading Blue Dogs, such as Arkansas Rep. Mike Ross, and also the newly minted chairman of the New Democrat Coalition, New York Rep. Joseph Crowley.

The discussion at the meeting centered on Medicare’s already controversial reimbursement rates for health care providers. Moderates echoed long-standing complaints from doctors and private insurers that the current rates are too low, particularly in under-served, rural communities.

Authors had already taken steps to remedy this perennial problem, one Congress addresses each year by approving tens of billions to reconcile the annual shortfalls. But they need to go further before many of these disgruntled moderates will sign on.

Those same critics also argued that using some multiple of Medicare’s reimbursement rate to determine payments under the government-sponsored coverage would give public plans an unfair advantage over private insurers and lead to deeper losses for doctors and other medical professionals.

“In order to establish a level playing field, providers must be fairly reimbursed at negotiated rates and their participation must be voluntary,” the Blue Dogs wrote in a letter signed by 40 lawmakers — just enough to derail any party-line bill.

“Medicare reimbursement is, on average, 20 to 30 percent lower than private plans, and this inequity is even greater in some parts of the country,” the Blue Dogs continued. “Using Medicare’s below-market rates would seriously weaken the financial stability of our local hospitals and doctors.”

“We can’t support a public option based on Medicare rates,” Ross said. “It doesn’t matter if it’s Medicare-plus-five or Medicare-plus-50.”

But there isn’t an easy remedy to these complaints. Padding the current reimbursement rates, for example, would add cost to the already astronomical price of health care reform. The same would prove true if Democrats didn’t peg payments under the public plans to Medicare.

And adding more money to the bill is the last thing conservative critics want to do.

During the two-hour negotiating session on Friday, many moderates adamantly objected to a proposal that doctors must participate in the public plans. They are also trying to shield small-business owners from a requirement that they provide health care for their employees or help pay for government coverage.

Readers' Comments (24)

Health care reform will be very hard to achieve but if the Democratic party with huge majorities in the House and 60 Democratic Senators doesn't achieve health care reform this year then the party will be wiped out in 2010.

The Republicans know this thus they will try to obstruct and delay as best they can.

If you people would do something as simple as go out and talk with someone on medicade or on the VA plan you would probably change your mind about wanting the government involved. But that’s too much for them to do, following blindly is much easier.

Even when BHO says in his own infomercial that his grandmother should be given more drugs so she doesn’t feel the pain instead of having surgery you still don’t grasp the picture in front of you.

Or when he basically said he could afford to go outside the system and save his family member, and wouldn’t rely on the public option like the poor would have to.

Let’s see you don’t work, & live on the tax payer’s dime, we can’t see putting any money into you for the surgery. Perhaps we can give you some better drugs so you can think the problem has been fixed.

I guess when reruns of CSI got more viewers no one would have seen the infomercial.

"Health care reform will be very hard to achieve but if the Democratic party with huge majorities in the House and 60 Democratic Senators doesn't achieve health care reform this year then the party will be wiped out in 2010.

The Republicans know this thus they will try to obstruct and delay as best they can."

Since they have the magic number 60 to get it passed without Republicans does it matter?

Or is it they don’t have enough followers in the BHO, Nancy, and Harry show to pass it themselves.

Republicans need not fear. The Health industry owns the Senate completely. The Senators need the campaign donations to keep there fat a@@@# in ofice so they will not support the people of the USA, these Senators want to keep their positions and will not vote to upset their gravy train. Americans - thirty million people without health insurance coverage that need the Senators to stand tall for them can expect the usual screwing, whats new!

The Senate should be the standing star in the defeat in this legislation. They can stop the maddness of socialistic medicine and long lines at Doctors offices to get to see someone to see if your elligable to see a Dr. This is not unreasonable to think since it is happening everywhere in the world that they have this type of medical coverage. There is no mystery why Canadians come her, Europe comes here, russia comes here, even our enemies flyin late at night to get some type of medical proceedures. WHY because we have the best medical proceedures and services in the WORLD. We may be expensive but we do have the service and attention. Do something about price but do not turn us into Europe of Canada with the Government in the middle of service. The Senate is the last hope to stop this and they should understand the political suicide of passing this Government grab.

Here's what this small business owner is telling the "moderate" Democrats: that health care reform bill better have a healthy, strong, viable public option or I and millions of other Democrats will be funding your primary opponents in 2010, 2012 and 2014. Is that clear?

“Medicare reimbursement is, on average, 20 to 30 percent lower than private plans, and this inequity is even greater in some parts of the country,” the Blue Dogs continued. “Using Medicare’s below-market rates would seriously weaken the financial stability of our local hospitals and doctors.”

thats right my elected official. as a medical provider I get slammed everytime I see a medicare patient. i love'em but they cost me money to see. that is why so many providers in my area, especially, specialists are not taking any new medicare patients. they cost too much to see. so if the proposed new single payer system that the liberals want so badly, they can have it but I won't be able to afford to see them and when others follow suit, they will be stuck because of their silly own ideas.

Here's what this small business owner is telling the "moderate" Democrats: that health care reform bill better have a healthy, strong, viable public option or I and millions of other Democrats will be funding your primary opponents in 2010, 2012 and 2014. Is that clear?

go ahead and fund them you knuckle head. get your public option, see private insurers go completely out of business, see your small business taxes go up to fund your ranting and then see providers like me not take public insurance because it costs me to much to pay for the overhead for the employees to complete the paperwork and bill the government provider...

from one business person to another, you my friend have no idea the costs it inolves to see a mediare/medicaid patient. do you k now why medicare's overhead is only 3%? because the over head costs, about 40% are put onto the medical provider's office. can you afford to have one of your employees do nothing but sit ona phone for 2-4 hours trying to get a 40$-80$ claim paid for? that is a poor return for your employees time. that is what happens to us...trying to get a government person on the phone who can help you takes hours....

you vote your way, i will vote mine, and I still don't have to accept government insurance...

It would be interesting to see if these "moderate Democrats" are from districts that would be better off with a government health plan, i.e., single payer. If they are from rural districts, a government plan would likely bring more services into the area. My brother lives in a rural area in upstate New York and had to travel 8 hours round trip to be treated for esophageal dysplasia, a precancerous condition. The local hospitals weren't up to the job. And thats upstate NY, which is pretty populous compared to rural areas of the west and midwest. And of course, the South has so much poverty that bringing any federal money in should be desirable. Many years ago, 20 or more, when I lived in NY, I remember seeing the late Sen. Moynihan on TV asked about federalized social spending and he said he had to be cautious because as much as he wanted to see poor people helped around the country, he knew that New York taxpayers were going to be paying for the services to Mississippi, etc.

So, here are these "moverate Democrats" and whose bidding are they doing? The moderate Dems must think their constituents are so Rush Limbaughized that they don't know their own interests and there's all that money to take from the special interests.

We want single -payer nationalized healthcare and a criminally enforced patient's Bill of Rights. We don't want mandatory, criminally enforced mandatory national insurance. Remove the all the insurance companies, it racketeering.

Re Medicare reimbursement rates: When I used to take my late mother to her cardiologist every 3 months, the doctor got almost $100 --- 4/5 medicare and another $18 from my mother. It was an office visit, no tests, no bloodwork, no machines. Unless the doctor could have jam-packed her schedule for every minute of the day, how was she losing money? And any time there were tests, that was an extra charge. Same thing with the primary care physician, how do you lose money on having a patient come in and get their blood pressure taken and their heart listened to and look in their eyes, etc.? I wonder how many doctors couldn't make a go of it without these reliable steady Medicare customers.

Figures don't lie but liars can figure. I guess theres some way to make a calculation that Medicare patients are "costing me money" but if you're not buying any special equipment for them or hiring extra staff, steady customers are an asset to paying the regular overhead in any business.

“Medicare reimbursement is, on average, 20 to 30 percent lower than private plans, and this inequity is even greater in some parts of the country,” the Blue Dogs continued. “Using Medicare’s below-market rates would seriously weaken the financial stability of our local hospitals and doctors.”

Blue Dogs are just the latest name for the Dixiecrats--the DCL types, the Bourbon Democrats, the DINOs and Boll Weavils--they have had many names in US history.

Those of us in the other sections do not want this country to be backward like the South, but as modern as Canada and Western Europe--not always lagging behind.

We do not want the whole US to have the social and economic policies of Texas, Louisiana, Oklahoma and Mississippi, although that seems to suit the people who live there, who have always been backward.

Let those Southern states just opt out of the public option if they don't want it. let them opt out of Medicare, Medicaid and the Union itself for all I care--just let the rest of us in the North and West have the kind of reforms we want.

So, here are these "moverate Democrats" and whose bidding are they doing? The moderate Dems must think their constituents are so Rush Limbaughized that they don't know their own interests and there's all that money to take from the special interests.

The Republicans and Dixiecrats are more afraid that Obama might be successful, and that they might even start to lose their lock on the South. That's one reason they are pulling out all the stops to try to ensure that his reforms are delayed to death, watered down or not passed at all.

I doubt that the Republicans will lose their hold on the Deep South, since they can always play the Race and Religion Cards constantly, and most of the white voters there are dumb enough to fall for this every time. In the rest of the country, though, they are going to be in serious trouble if Obama is successful in all he's trying to do.

That’s absolutely correct and it doesn’t even address the cost shifting that takes place because of Medicare and other gov’t programs. For example, if I am a hospital, have 2 patients receiving the same treatment (one on a private plan and one on a gov’t plan), and need to make $1 to break even, the fair thing would be for each patient’s reimbursement to be $0.50. But b/c the government only reimburses $0.30 the hospital is forced to cost shift to the private plan patient the $0.20 that the gov’t refuses to pay forcing the private plan to pay $0.70 for the same treatment. This cost shifting results in increase cost to the private plan and results in higher premiums, deductibles, and copays to the private plan member.

Maybe the executives don't deserve seven figure salaries and seven figure bonuses every year! Did you ever consider that? Cut the excessive executive salaries and the cost would go down drastically. Wing nut chowder heads like you don't think in those terms you think the CEO and the rest of the bean counters and white collar creeps. Actually deserve to make four of five times what the Doctors and Nurses who actually provide the care do... This is something you will hate but it will fix the problem no bonus checks for the executives no stock options health care should not be publicly traded stock no stock dividends made from people needing health care. For profit health care is about just that making a profit not providing heath care.

Insurance, particularly health care insurance, is the greatest scam in history. We pay thousands upon thousand of dollars each and every year and, increasingly, we get NO GOODS OR SERVICES. In essence, we pay out billions of dollars for ABSOLUTELY NOTHING. We are in fact, making a handful of these huge industry titans, i.e. the top echelon CEO's CFO's, etc. of the so-called health care industry, a veritable FORTUNE.

Simply stated, when any industry is driven by profit and profit alone, AS IS HEALTH CARE, they, the controllers of the industry, reap dizzying and obscene amounts of money. WE, on the other hand, LOSE consistently and constantly. Profit-driven health care is an absolute NEMESIS.

As this health care industry makes record profits from not providing health care to those who pay for health care, the industry also becomes much stronger and much more influential (witness the ULTRA-powerful and ULTRA-wealthy lobbyists who fight tooth and nail to keep things the way they are).

How long does it take the average person to figure out that we are all getting UTTERLY and UNABASHEDLY RAPED????

Insurance, particularly health care insurance, is the greatest scam in history. We pay thousands upon thousand of dollars each and every year and, increasingly, we get NO GOODS OR SERVICES. In essence, we pay out billions of dollars for ABSOLUTELY NOTHING. We are in fact, making a handful of these huge industry titans, i.e. the top echelon CEO's CFO's, etc. of the so-called health care industry, a veritable FORTUNE.

Simply stated, when any industry is driven by profit and profit alone, AS IS HEALTH CARE, they, the controllers of the industry, reap dizzying and obscene amounts of money. WE, on the other hand, LOSE consistently and constantly. Profit-driven health care is an absolute NEMESIS.

As this health care industry makes record profits from not providing health care to those who pay for health care, the industry also becomes much stronger and much more influential (witness the ULTRA-powerful and ULTRA-wealthy lobbyists who fight tooth and nail to keep things the way they are).

How long does it take the average person to figure out that we are all getting UTTERLY and UNABASHEDLY RAPED????

If the Southern states do not want the public option, then by all means let them opt out. Write that into the legislation that states can choose whether to participate in it or not. Medicaid was like that, originally.

If the South wants states rights, then by all means let them have it. Everyone gets a choice, and everyone's happy. What could be fairer than that?

Amen!! The blue dogs are whining and dragging their tails behind them because they might miss out on the non stop gravy train offered by the insurance cyclops. The South is STILL the most ignorant, backward, self righteous area of the country. They and their reps are stopping the rest of us from moving forward. Their revenge for losing the war.